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The myths of cataract surgery

May. 30, 2011

Like thousands of Canadians, Maya Thorensen assumed that only old people got cataracts. But when the Whitby, Ontario teacher's vision began to deteriorate three years ago to the point where she couldn't clearly see the students at the back of her class, she consulted her eye doctor, who told her that she'd need surgery rather than just a stronger prescription for her eyeglasses.

Thorensen (not her real name) was shocked to learn that her vision needed surgery to correct it. She was only 47 at the time and her only experience with cataracts was the memory of her grandmother who had been hospitalized for days post-eye surgery. But even after surgery, Grandma had to wear Coke-bottle-thick glasses.

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Fortunately, we've progressed mightily from those days. More than 250,000 cataracts are removed as day surgeries each year in Canada; the minimally-invasive surgery takes less than an hour, on average. But people are still in the dark as to what cataracts are, how they evolve, why they may need removal, and how it's done.

A cataract is the clouding of the natural clear lens inside the eye; the lens is located behind the iris and the pupil. Blurred vision, difficulty with glare and visual changes are symptoms: Thorensen described her cataract experience as "looking through a greasy windshield or a veil."

"Many people don't realize that 100% of the population will experience loss of their reading vision, called presbyopia, and a cataract as they grow older," says Dr. Sheldon Herzig, medical director of the Herzig Eye Institute in Toronto. Here's what happens: That natural lens is mostly made of water and protein arranged in a way that keeps the lens clear and lets light pass through it so that we can see clearly.

As we age, some of the protein can clump together and start to cloud the lens. This is a cataract, and as it expands in size, it makes it harder to see. Early-stage cataracts are treated with new glasses, but when cataracts fully cloud the lens (this is known as becoming "ripe"), surgery is usually required.

In the really old days (the fifth century BC), cataract surgery was akin to having a needle poked in your eye in order to dislodge a cloudy lens, says Dr. Herzig. The technique, known as couching, restored limited but unfocused vision; the lens was not replaced. "At least it enabled the patient to get some light in and see some shapes," he adds, explaining that the procedure went through several different forms over the years.

Today, he says, intravenous sedation is given for relaxation while the cataract surgery is done through a tiny wound of about 2 mm in the anesthetized eye. The old, clouded lens is removed and replaced with a new intraocular lens that can correct and restore vision. (Thorensen, for instance, can now see the blackboard from the far end of her classroom and only needs reading glasses to mark her kids' essays. But some people opt for multifocal intraocular lenses that can address near, intermediate and far distances simultaneously so that distance or reading glasses are no longer required.)

One of the myths about cataract surgery is that it's done by laser. "We use ultrasound energy," says Dr. Herzig. "That's modern technology - beautiful and very safe." The new lens that replaces the clouded lens sits right in where the old one was. "We determine what lens power to put in based on mathematical formulas, and there are subtle variations patient to patient."

Cataract surgery continues to evolve as new lenses and procedures are invented: "The ultimate goal is to design a lens that will work like our natural lenses did when we were 20," says Dr. Herzig. "That's the holy grail of lens surgery." We're not there yet, but what we have is better than in Grandma's day.

Cataract myths

  • Cataracts can be treated with eye drops or vitamins. (Surgery is the only cure.)
  • Recovery is long. (It's an out-patient procedure; most people have good vision within two days.)
  • Lasers are used. (Ultrasound energy is used to remove cataracts.)
  • Suturing is required. (No sutures - the lens is just placed in the capsule of a X person's natural lens.)
  • Cataracts are for old people. (They can form at any age.)
  • You still need glasses. (If you choose a multifocal intraocular lens, you may not.)

Why not ignore them?

  • Cataracts cut down on what Dr. Herzig calls "contrast acuity," which means that the contrast between what you are trying to see and its background is reduced. "You can read the 20/20 line in the doctor's office because the room is dark and you're looking at black letters against white. But that's not real life."
  • Symptoms include problems with glare, difficulty seeing at night, blurred vision, frequent changes in your eyeglass or contact lens prescription, seeing halos around lights.
  • Cataracts are the leading cause of blindness in the world and the leading cause of vision loss in Canada.
  • Results of an Australian study showed that cataract surgery not only improves vision but also reduces car crashes in patients aged 60 plus.

 

Cataracts 101

In Ontario, cataract surgery, including the insert of a standard lens, is covered by OHIP. Patients pay for the difference between a standard lens and a premium or multifocal lens. Waiting times for hospital cataract surgery vary; private clinics have less waiting times but can cost about $3,000 to $5,000 per eye, depending on the type of lens. More on cataracts can be found at the following:

Health Services Canada, www.hc-sc.gc.ca

The Canadian Ophthalmological Society, www.eyesite.ca

Herzig Eye Institute, www.herzig-eye.com

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